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NPTE Study Guide 2
NPTE Week 2 - Orthopedic/Neuromuscular
115
Other
Graduate
07/09/2011

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Term
WIth avascular necrosis, hip ROM is decreased in what 3 motions?
Definition
abduction, flexion, & IR
Term
With Legg-Calve-Perthe's disease, what is the cause, presentation, & limitations in ROM?
Definition
have inadequate blood supply to part of hip & bone can become unstable, break easily, and heal poorly. weakness of psoas major - affected LE moves in flexion, adduction, & ER - limited in extension & ABD
see positive bony crescent sign - collapse of subchondral bone at femoral neck/head
Term
List the hip ROM limitations with SCFE.
Definition
hip abduction, flexion, & IR
Term
What is considered "exessive anteversion"?
Definition
>30 degrees
Term
What does excessive femoral anteversion lead to?
Definition
squinting patellae & in-toeing.
Term
List the values that define coxa vara & valga.
Definition
<120 - coxa vara
>135 - coxa valga
Term
coxa vara usually occurs from a defect with what?
Definition
ossification of the femoral head
Term
The piriformis can become overworked with what motion of the foot?
Definition
overpronation. - causes tibial and femoral internal rotation.
Term
With piriformis syndrome you will see a _______ in internal rotation & weakness in _______.
Definition
restriction, external rotators
Term
List the 3 classifications of knee ligament sprains.
Definition
1st - little or no instability
2nd - mild to moderate instability
3rd - severe instability
Term
Describe patella alta.
Definition
abnormal superior tracking of the patella - could result in chronic patellar subluxation & positive camel-back sign - two bumps over anterior knee region instead of 1 - first is patella & 2nd is tibial tuberosity
Term
Describe patella baja.
Definition
abnormal inferior patellar tracking - results in restricted knee extension with abnormal cartilaginous wearing resulting in DJD
Term
Lateral patellar tracking could result if there is an increase in _____ with a tendency for lateral subluxation or dislocation.
Definition
Q angle
Term
Diagnostic tests utilized for patellofemoral conditions include ____ view x-ray.
Definition
sunrise
Term
Normal tibiofemoral shaft angle is _____.
Definition
6 degrees of valgum.
Term
Genu varum is an excessive _____ tibial torsion commonly referred to as "bowlegs". Results in excessive _____ patellar positioning & pigeon-toed orientation of feet.
Definition
medial, medial
Term
Genu valgum is an excessive ____ tibial torsion commonly referred to as "knock-knees." Results in excessive _____ patellar positioning.
Definition
lateral, lateral
Term
Which femoral condyle is most often involved in fractures?
Definition
medial
Term
What is a common MOI for a tibial plateau fracture?
Definition
combo of valgum & compression forces to knee when the knee is in a flexed position.
Term
What muscles are involved with anterior tibial periostitis?
Definition
tibialis anterior and extensor hallucis longus
Term
What muscles are involved with medial tibial stress syndrome?
Definition
posterior tibialis & medial soleus
Term
What percentages of stress fractures occur in the tibia & fibula?
Definition
49% - tibia
10% - fibula
Term
95% of all ankle sprains involve the ____ ligaments.
Definition
lateral
Term
WIth lateral sprains, the foot is ____ & ____ at the time of injury.
Definition
plantarflexed & inverted
Term
List the grading system for ankle sprains.
Definition
Grade I: No loss of function with minimal tearing of ATF ligament

Grade II: some loss of function with partial disruption of the ATF & calcaneofibular ligament

Grade III: Complete loss of function with complete tearing of the ATF & calcaneofibular ligaments with partial tear of the posterior talofibular ligament.
Term
Trimalleolar fracture involves the medial & lateral malleoli, & the _____.
Definition
posterior tubercle of the distal tibia.
Term
What is the difference between postural and talipes equinovarus?
Definition
postural equinovarus results from improper positioning in utero

Talipes equinovarus is an abnormal development of the head of the talus
Term
What is the observed deformity with equinovarus and equinus?
Definition
equinovarus - adduction, plantarflexion & inverted foot

equinus - plantarflexion (either of forefoot or rearfoot)
Term
Describe the observed deformity of hallux valgus.
Definition
medial deviation of the head of the first metatarsal from the midline of the body: metatarsal & base of proximal first phalanx moves medially, distal phalanx moves laterally.
Term
List the mechanical and structural causes of metatarsalgia.
Definition
mechanical: tight triceps surae group and/or Achilles tendon, collapse of transverse arch, short first ray, pronation of forefoot

Structural: changes in transverse arch possibly leading to vascular and/or neural compromise in tissues of forefoot
Term
Describe the observed deformity of metatarsus adductus.
Definition
Rigid: medial subluxation of the TMT joints - hindfoot is slightly in valgus with navicular lateral to the head of the talus

Flexible: adduction of all five metatarsals at the tarsometatarsal joints
Term
List the cause of Charcot-Marie-Tooth disease & its progression.
Definition
peroneal muscular atrophy that affects motor & sensory nerves

initially affects the muscles in the lower leg & foot, but eventually progresses to muscles of the hand and forearm
Term
List the differential diagnosis for esophageal cancer.
Definition
Difficulty swallowing, pain radiating to the back, dysphagia, & weight loss
Term
List the differential diagnosis for pancreatic cancer.
Definition
Deep gnawing pain that may radiate from chest to back.
Term
List the manifestations of acute pancreatitis.
Definition
mid-epigastric pain that radiates through the back.
Term
List the manifestations of cholecystitis.
Definition
severe abdominal pain & RUQ tenderness, nausea, vomiting, & fever.
Term
AAA can manifest itself as _______.
Definition
nonspecific lumbar pain.
Term
Primary joint glide of the TMJ is ____. What does this glide do?
Definition
inferior - gaps joint, stretches capsule, & allows relocation of anteriorly displaced disc
Term
What is Rocobado's jaw opening exercise?
Definition
jaw opening while maintaining the tongue in contact with the palate & isometric mandibular exercises
Term
What is the "gold standard" test to diagnose a RC tear?
Definition
arthrogram
Term
Describe rehab for early flexor tendon repairs in terms of how long the patient is immobilized, in what position, & what motions are initially contraindicated.
Definition
First 3-4 wks, distal extremity is immobilized with a protective spint that keeps IP joints in 30-50 deg. flexion with rubber bands

Resisted extension and passive flexion can be performed within contraints of splint

active extension initiated before active flexion
Term
Describe extensor tendon repairs in terms of how long the patient is immobilized and in what position, and what motions are originally contraindicated.
Definition
Patient is placed in a splint with DIP at neutral for 6-8 weeks. Active extension is initiated first, then flexion

Proximal repairs are immobilized with the wrist and digital joints in extension for 4 weeks
Term
Briefly describe the differences between cemented and non-cemented THA patients.
Definition
cemented hips can tolerate FWB immediately following surgery, but can crack with age, causing a loosening of the prosthesis - better for patients with fragile bones or would benefit from ability to immediately bear weight

Non-cemented technique is more stressful on bones during surgical procedure, but is better for younger/more active individuals.
Term
List the hip precautions after a THA & how long they must be implemented.
Definition
No hip flexion past 90 deg., IR, or ADD for 3-6 months post-op
Term
With a hip ORIF following fracture, how long are patients typically NWB?
Definition
1-2 weeks and then PWB as tolerated.
Term
With cemented vs. non-cemented THA patients, how long are they non weight-bearing? When can each ambulate? When are they FWB?
Definition
Cemented - PWB for 3 wks, then cane at 4, and FWB at 5

Non
WBAT - PWB for 3, cane at 4, FWB at 6
TDWB - 1/3 wb at 6 wks, 2/3 at 8 wks, FWB week 10, cane week 12, no AD after that.
Term
Describe cement vs. non cement prosthesis for TKA.
Definition
Cement - WBAT after surgery
Non-cement - wb-ing 1-7 weeks 25%, 8 - 50%, 75% at week 10, & 100% w/o AD by week 12
Term
List the ROM goals for weeks 1-2 & 3-4 after TKA.
Definition
1-2 - 0-90 deg. - don't want to go past 90 b/c of constraints of prosthesis
3-4 - 0-120.
Term
Describe general procedure for ACL & PCL repair patients.
Definition
ACL - CPM utilized after surgery for PROM 0-70, increased to 0-120 by week 6, reconstruction is protected with hinged brace set at 20-70 deg. flexion initially, NWB week 1 and progresses after that to WBAT to full, weaned from brace btwn weeks 2-4.

PCL - same but brace is set at neutral (0 deg.)
Term
When is a lateral retinacular release of the knee performed?
Definition
as a result of patellofemoral pain syndrome - purpose is to restore normal tracking of the patella during contraction of quads
Term
Describe rehab for a partial meniscectomy vs. menicsus repair.
Definition
partial meniscectomy - PWBAT when full knee ext. is obtained - AROM post-op day 1, strengthening by day 3, & later jogging on heel or ball of foot to decrease loading of knee joint

Repairs - NWB 3-6 weeks, rehab begins 7-10 days after
Term
WIth multilevel vertebral fusions, typically ___ weeks of trunk immobility with bracing is required.
Definition
6
Term
With a particular technique during spinal surgery, bracing is seldom used post-op. What is this technique?
Definition
combined anterior/posterior surgical approach
Term
Describe early rehab after Harrington rod placement.
Definition
focus is on coughing ability and bed mobility - ambulation is permitted 4-7 days post-op
Term
What is the Feldenkrais technique?
Definition
facilitates development of normal movement patters - use skillful, supportive, gentle hands to create a sense of safety, maintain supportive contact, while introducing new movement possibilities in small, easily available increments.
Term
Breifly list some pros/cons for Hamstring vs. Patellar tendon ACL grafts.
Definition
Hamstring: Pros: typically fewer symptoms post-op, greater return to pre-injury level, allows earlier rehab
Cons: expensive, more difficult technique, rehab is slower

Patellar tendon: less expensive, better at maintaining graft tension post-op, faster healing time
Cons: increased potential for ant. knee pain & later patellofemoral osteoarthrosis, increased potential for knee extension deficit, & potential delay in rehab secondary to more atrophy of quads.
Term
List adverse side-effects of COX-1 & COX-2 inhibitors.
Definition
NSAIDS

COX-1 - general - GI irritation, fluid retention, renal or liver problems, and prolonged bleeding

COX-2 - selective - decreased GI side-effects, but can cause heart-related conditions (Celebrex, Bextra)
Term
List examples & adverse side effects of muscle relaxants.
Definition
Cyclobenzaprine HCl (Flexeril), Methocarbamol (Robaxim), & carisoprodol (Soma)

drowsiness, lethargy, ataxia, & decreased alertness
Term
List the adverse side effect of too much acetaminophen.
Definition
liver disease or acute liver shutdown
Term
Describe Hoover's test.
Definition
evaluation of amount of pressure the patient's heels place on the therapist's hands when the patient is asked to raise one LE in the supine position.
Term
What is the functional unit of the nervous system?
Definition
neuron - have nerve cell body, dendrites, & axon.
Term
Define glia.
Definition
non-neuronal cells that provide services to neurons (protect, nourish, support)
Term
white matter is composed of ____ & ____.
Definition
axons & myelin
Term
List the different names of bundles of myelinated axons that travel together in the CNS.
Definition
tract, peduncle, column, capsule, lemniscus, fasciculus
Term
What is gray matter composed of?
Definition
neuronal cell bodies.
Term
groups of neuron cell bodies in the CNS are called _______ & in the PNS they are called ______.
Definition
nuclei; ganglia
Term
gray matter on the surface of the brain is called ____.
Definition
cortical matter or cortex
Term
The axons in white matter _____. What does the gray matter do?
Definition
convey information along parts of the nervous system

gray - information is integrated here.
Term
The spinal cord runs from the foramen magnum to the level of the ____ lumbar vertebra & ends in the ______.
Definition
1st; conus medullaris
Term
How many cranial nerves exit from the medulla? the pons? the midbrain?
Definition
medulla - 4
pons - 4
midbrain - 2
Term
The anterior portion of the midbrain features what? What about the posterior midbrain?
Definition
anterior - two cerebral peduncles
posterior - tectum of midbrain has four small rounded bodies - two superior & two inferior colliculi
Term
Where are the colliculi and what are they important in functioning?
Definition
auditory & visual stimuli - tectum of midbrain
Term
List the purely sensory cranial nerves.
Definition
olfactory (I), optic(II), verstibulocochlear (VIII)
Term
List the motor only cranial nerves.
Definition
oculomotor (III), trochlear (IV), abducens (VI), acessory (XI), & hypoglossal (XII)
Term
List the mixed cranial nerves.
Definition
Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X)
Term
List the function of the first 4 cranial nerves.
Definition
Olfactory - sense of smell
Optic - sight
Oculomotor - eye movements - moves eyes up, down, medially, raises upper eyelid, & constricts pupil
Trochlear - moves eye medially & down
Term
List the function of cranial nerves V-VIII.
Definition
Trigeminal nerve - facial sensation, chewing, & sensation from TMJ
Abducens - abducts eye
Facial - facial expression, closes eyes, tears, salivation, & taste
Vestibulocochlear - sensation of head position relative to gravity & head movement & hearing
Term
List the function of cranial nerves IX-XII.
Definition
Glossopharyngeal (IX) - swallowing, salivation, & taste
Vagus (X) - regulates viscera, swallowing, speech, & taste
Accessory (IX) - elevates shoulders, turns head
Hypoglossal (XII) - tongue movements
Term
The superior, middle, & inferior ______ join the midbrain, pons, & medulla to the cerebellum.
Definition
cerebellar peduncles.
Term
List the four structures that make up the diencephalon.
Definition
thalamus, hypothalamus, epithalamus, & subthalamus
Term
List the purpose of the thalamic nuclei.
Definition

relay info the the cerebral cortex, process emotional & some memory information, integrate sensation, regulate consciousness, arousal, & attention

 

hypothalamus maintains body temp., metabolic rate, & chemical composition of tissues & fluids within optimal range - also regulates eating, reproduction, defensive behaviors, expression of emotions, growth, & function of reproductive organs

 

epithalamus consists of primarily pineal gland - influences secretion of other endocrine glands, including the pituitary & adrenal glands

 

subthalamus - part of a neural circuit controlling movement

Term
What are the six lobes of the brain?
Definition
frontal, parietal, temporal, occipital, limbic, insula
Term
The entire surface of the cerebral hemispheres is composed of gray matter. Deep to the cortex is white matter. What are collections of white matter fibers in this region that are of particular interest?
Definition
commissures (corpus callosum) - bundles of axons that convey info between right & left cerebral hemispheres & internal capsule- axons projecting from cerebral cortex to subcortical structures & vice-versa - has ant. & post. limbs with a genu (bend) between them
Term
Within the white matter inside the gray matter of the cerebral hemispheres, there is additional gray matter, the most prominent being the basal ganglia. What are the basal ganglia nuclei?
Definition
putamen, globus pallidus, caudate, subthalamic, & substantia nigra
putamen + globus pallidus = lenticular nucleus
putamen + caudate = corpus striatum
Term
where is the substantia nigra located?
Definition
in the midbrain
Term
The lateral ventricles are connected to the third ventricle by the _______.
Definition
interventricular foramina
Term
The third & fourth ventricles of the brain are connected by the ____.
Definition
cerebral aqueduct.
Term
Describe the falx cerebri & the tentorium cerebelli. What layers of the meninges do they arise from?
Definition
both dura mater projections - falx cerebri separates the two cerebral hemispheres; tentorium cerebelli separates the posterior cerebral hemispheres from the cerebellum.
Term
List the blood supply to the spinal cord.
Definition
the posterior spinal arteries supply posterior third of cord, anterior supplies anterior 2/3 (both branches of vertebral artery)
also supplied by medullary arteries
Term
List the three main branches of the vertebral artery & what they supply.
Definition
anterior spinal arteries - spinal cord
posterior spinal arteries - spinal cord
posterior inferior cerebellar artery - inf. cerebellum

all three branches supply medulla
Term
List the branches of the basilar artery & what they supply.
Definition
anterior inferior cerebellar artery - most of cerebellum
superior cerebellar artery
- both supply pons
Term
At the junction of the midbrain & pons, the basilar artery divides to become the _______, which supply what?
Definition
posterior cerebral arteries - primary blood supply to midbrain, occipital lobe, medial & inferior temporal lobes
Term
What forms the circle of Willis?
Definition
anterior & posterior cerebral arteries, internal carotid artery, & ant. & post. communicating branches.
Term
List what the anterior cerebral artery supplies.
Definition
medial surface of the frontal & parietal lobes.
Term
List what the MCA supplies.
Definition
internal capsule, globus pallidus, putamen, caudate - most of lateral hemisphere
Term
The anterior choroidal artery is a branch of the ______, and supplies...
Definition
internal carotid
supplies choroid plexus of lat. ventricle, parts of visual pathway (optic tract & radiations), putamen, thalamus, internal capsule, & hippocampus
Term
What results from damage to the oculomotor nerve?
Definition
ptosis, dilation of pupil, loss of accomodation to light reflex
Term
What results from damage to the trochlear nerve?
Definition
failure to rotate the eye up & out (innervates superior oblique) & diplopia
Term
What results from damage to the abducens nerve?
Definition
medial strabismus, diplopia, & abductor paralysis in ipsilateral eye
Term
What vertebral level is the spine of the scapula?
Definition
T3
Term
What vertebral level is the xiphoid process of the sternum?
Definition
T7
Term
What landmarks are at T10?
Definition
belly button
Term
What vertebral level is the iliac crest located?
Definition
L4
Term
What vertebral level is the PSIS?
Definition
S2
Term
What is the capsular pattern of the hip?
Definition
flexion>IR>ABD
Term
What is the capsular pattern for the toes?
Definition
extension>flexion
Term
List areas on the body that correspond to dermatomes C2-T1 & L2-S2.
Definition
C2 - occiput
C3 - sides of neck
C4 - tops of shoulders
C5 - front of biceps
C6 - thumb
C7 - digits 2 & 3
C8 - digits 4 & 5
T1 - upper chest

L2 - upper thigh - swoops down medially
L3 - just above knee on medial side swoops down to medial knee
L4 - anterior surface of knee over patella swoops down and in over medial tibia
L5 - web space and most of dorsum of foot
S1 - lateral calf (posteriorly)
S2 - medial calf (posteriorly)
Term
Anticholinergic drugs (benztropine, oxybutynin, & Artane) for muscle spasm or PD can have side effects such as ____, ____, ___, & _____. What are signs of toxicity.
Definition
dry skin, no sweating, palpitations, mental status changes

toxicity causes patient to be dry, hot , & mad
Term
List the cord levels for the following reflexes: biceps, brachioradialis, triceps, patellar tendon, Achilles tendon.
Definition
biceps (C5)
brachioradialis (C6)
triceps (C7)
patellar tendon (L3-4)
Achilles tendon (S1-2)
Term
List Fryette's 3 laws.
Definition
1: in neutral, spinal segments side-bend & rotate to opposite sides
2: in flexion or extension, side-bending occur to the same side
3: taking up a segment with one motion limits the other two motions
Term
What indicates denervation during a nerve conduction velocity test? What about reinnervation? No denervation (neuropraxia)?
Definition
denervation - spontaneous fibrillation potentials & positive sharp waves on EMG 2-3 wks after injury

reinnervation - polyphasic motor units of low amplitude & short duration

Neuropraxia - no spontaneous activity
Term
Piriformis can be overworked with excessive foot ____, which causes abnormal femoral _____ rotation. Signs & symptoms of piriformis syndrome include restriction in hip ____, pain with palpation of piriforms, referral of pain to ____, & weakness in ____ with positive piriformis test
Definition
pronation, internal
internal rotation, posterior thigh
external rotation
Term
Describe the piriformis test.
Definition
Patient supine with foot of test leg passively placed lateral to opposite limb's knee - testing hip is adducted - observe position of testing knee relative to the opposite knee - positive if the testing knee is unable to pass over the resting knee and/or reproduction of pain in the buttock or along sciatic nerve distribution.
Term
With a L scoliosis, what happens to the L shoulder, L scapula, & L hip?
Definition
L shoulder elevated, L scapula is prominent & protruding, L hip normal - would be R hip protruding
Term
List the muscles and cord levels for the UE & LE muscles with the ASIA scale.
Definition

UE

C5 - elbow flexors

C6 - wrist extensors

C7 - elbow extensors

C8 - finger flexors

T1 - finger ABD

 

LE

L2 - hip flexors

L3 - knee extensors

L4 - DF

L5 - great toe ext.

S1 - plantar flexion

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